Get Dr. Lena Kian Naturopathic Doctor Patient Information Form (please ...

Completing the Dr. Lena Kian Naturopathic Doctor Patient Information Form is a straightforward process that helps ensure your health information is accurately recorded. This guide will walk you through each section of the form, providing clear instructions to help you fill it out efficiently.

Follow the steps to successfully complete the patient information form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, fill in your last name, first name, and middle initial. Ensure that you write clearly for easy readability.
3. If applicable, provide any other names or a maiden name you may have. Enter your date of birth and select your sex from the provided options.
4. Complete your address including apartment number if relevant, city, state, and zip code. Accuracy in this section is crucial for correspondence.
5. Input your home phone, work phone, and cell phone numbers. Make sure that these numbers are current and correct.
6. Enter your email address. Additionally, indicate whether you would like to receive the confidential email newsletter by selecting 'YES' or 'NO'.
7. Provide your occupation and the name of your employer along with the employer's phone number for any necessary communications.
8. For minors, fill in the names of the mother and father as required. If this does not apply to you, you can skip this step.
9. Provide the name and phone number of an emergency contact, including their relationship to you.
10. Enter the name and phone number of your primary care physician, along with their address. This information may be crucial for your health care.
11. Indicate the date of your last physical exam for your medical records.
12. Respond to the question regarding special needs and any visual or hearing impairments by selecting 'Yes' or 'No' as appropriate.
13. In the last section, indicate how you heard about the clinic by circling one of the provided options.
14. Finally, affirm that the information provided is true by signing and dating the form. Make sure to either save your changes, download the completed form, or share it as needed.

Get started completing your patient information form online now!